Relationship between Background Parenchymal Enhancement on High-risk Screening MRI and Future Breast Cancer Risk

Published:March 27, 2018DOI:

      Rationale and Objectives

      To determine if background parenchymal enhancement (BPE) on screening breast magnetic resonance imaging (MRI) in high-risk women correlates with future cancer.

      Materials and Methods

      All screening breast MRIs (n = 1039) in high-risk women at our institution from August 1, 2004, to July 30, 2013, were identified. Sixty-one patients who subsequently developed breast cancer were matched 1:2 by age and high-risk indication with patients who did not develop breast cancer (n = 122). Five fellowship-trained breast radiologists independently recorded the BPE. The median reader BPE for each case was calculated and compared between the cancer and control cohorts.


      Cancer cohort patients were high-risk because of a history of radiation therapy (10%, 6 of 61), high-risk lesion (18%, 11 of 61), or breast cancer (30%, 18 of 61); BRCA mutation (18%, 11 of 61); or family history (25%, 15 of 61). Subsequent malignancies were invasive ductal carcinoma (64%, 39 of 61), ductal carcinoma in situ (30%, 18 of 61) and invasive lobular carcinoma (7%, 4of 61). BPE was significantly higher in the cancer cohort than in the control cohort (P = 0.01). Women with mild, moderate, or marked BPE were 2.5 times more likely to develop breast cancer than women with minimal BPE (odds ratio = 2.5, 95% confidence interval: 1.3–4.8, P = .005). There was fair interreader agreement (κ = 0.39).


      High-risk women with greater than minimal BPE at screening MRI have increased risk of future breast cancer.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Centers for Disease Control and Prevention
        Breast Cancer Statistics.
        (Available at:)
        • Mainiero M.B.
        • Lourenco A.
        • Mahoney M.C.
        • et al.
        ACR Appropriateness Criteria breast cancer screening.
        J Am Coll Radiol. 2016; 13: R45-R49
        • Saslow D.
        • Boetes C.
        • Burke W.
        • et al.
        American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography.
        CA Cancer J Clin. 2007; 57: 75-89
        • Berg W.A.
        Tailored supplemental screening for breast cancer: what now and what next?.
        AJR Am J Roentgenol. 2009; 192: 390-399
        • Phi X.A.
        • Houssami N.
        • Obdeijn I.M.
        • et al.
        Magnetic resonance imaging improves breast screening sensitivity in BRCA mutation carriers age >/= 50 years: evidence from an individual patient data meta-analysis.
        J Clin Oncol. 2015; 33: 349-356
        • Medeiros L.R.
        • Duarte C.S.
        • Rosa D.D.
        • et al.
        Accuracy of magnetic resonance in suspicious breast lesions: a systematic quantitative review and meta-analysis.
        Breast Cancer Res Treat. 2011; 126: 273-285
        • Plevritis S.K.
        • Kurian A.W.
        • Sigal B.M.
        • et al.
        Cost-effectiveness of screening BRCA1/2 mutation carriers with breast magnetic resonance imaging.
        JAMA. 2006; 295: 2374-2384
        • Taneja C.
        • Edelsberg J.
        • Weycker D.
        • et al.
        Cost effectiveness of breast cancer screening with contrast-enhanced MRI in high-risk women.
        J Am Coll Radiol. 2009; 6: 171-179
        • Engmann N.J.
        • Golmakani M.K.
        • Miglioretti D.L.
        • et al.
        Population-attributable risk proportion of clinical risk factors for breast cancer.
        JAMA Oncol. 2017; 3: 1228-1236
        • Jeffers A.M.
        • Sieh W.
        • Lipson J.A.
        • et al.
        Breast cancer risk and mammographic density assessed with semiautomated and fully automated methods and BI-RADS.
        Radiology. 2017; 282: 348-355
        • Pettersson A.
        • Graff R.E.
        • Ursin G.
        • et al.
        Mammographic density phenotypes and risk of breast cancer: a meta-analysis.
        J Natl Cancer Inst. 2014; 106
        • Hu X.
        • Jiang L.
        • Li Q.
        • et al.
        Quantitative assessment of background parenchymal enhancement in breast magnetic resonance images predicts the risk of breast cancer.
        Oncotarget. 2017; 8: 10620-10627
        • Bennani-Baiti B.
        • Dietzel M.
        • Baltzer P.A.
        MRI Background parenchymal enhancement is not associated with breast cancer.
        PLoS ONE. 2016; 11 (e0158573)
        • Mazurowski M.A.
        • Zhang J.
        • Grimm L.J.
        • et al.
        Radiogenomic analysis of breast cancer: luminal B molecular subtype is associated with enhancement dynamics at MR imaging.
        Radiology. 2014; 273: 365-372
        • King V.
        • Brooks J.D.
        • Bernstein J.L.
        • et al.
        Background parenchymal enhancement at breast MR imaging and breast cancer risk.
        Radiology. 2011; 260: 50-60
        • Dontchos B.N.
        • Rahbar H.
        • Partridge S.C.
        • et al.
        Are qualitative assessments of background parenchymal enhancement, amount of fibroglandular tissue on MR images, and mammographic density associated with breast cancer risk?.
        Radiology. 2015; 276: 371-380
        • Ikeda D.M.
        • Hylton N.M.
        • Kuhl C.K.
        • et al.
        BI-RADS: Magnetic Resonance Imaging.
        in: D'Orsi C.J. Mendelson E.B. Ikeda D.M. Breast Imaging Reporting and Data System: ACR BI-RADS—Breast Imaging Atlas. 5th ed. American College of Radiology, Reston, VA2013
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Sprague B.L.
        • Gangnon R.E.
        • Burt V.
        • et al.
        Prevalence of mammographically dense breasts in the United States.
        J Natl Cancer Inst. 2014; 106
        • Melsaether A.
        • McDermott M.
        • Gupta D.
        • et al.
        Inter- and intrareader agreement for categorization of background parenchymal enhancement at baseline and after training.
        AJR Am J Roentgenol. 2014; 203: 209-215
        • DeLeo 3rd, M.J.
        • Domchek S.M.
        • Kontos D.
        • et al.
        Breast MRI fibroglandular volume and parenchymal enhancement in BRCA1 and BRCA2 mutation carriers before and immediately after risk-reducing salpingo-oophorectomy.
        AJR Am J Roentgenol. 2015; 204: 669-673
        • King V.
        • Gu Y.
        • Kaplan J.B.
        • et al.
        Impact of menopausal status on background parenchymal enhancement and fibroglandular tissue on breast MRI.
        Eur Radiol. 2012; 22: 2641-2647
        • Preibsch H.
        • Wanner L.
        • Bahrs S.D.
        • et al.
        Background parenchymal enhancement in breast MRI before and after neoadjuvant chemotherapy: correlation with tumour response.
        Eur Radiol. 2016; 26: 1590-1596
        • Price E.R.
        • Brooks J.D.
        • Watson E.J.
        • et al.
        The impact of bilateral salpingo-oophorectomy on breast MRI background parenchymal enhancement and fibroglandular tissue.
        Eur Radiol. 2014; 24: 162-168
        • Scaranelo A.M.
        • Carrillo M.C.
        • Fleming R.
        • et al.
        Pilot study of quantitative analysis of background enhancement on breast MR images: association with menstrual cycle and mammographic breast density.
        Radiology. 2013; 267: 692-700
        • Tagliafico A.
        • Bignotti B.
        • Tagliafico G.
        • et al.
        Quantitative evaluation of background parenchymal enhancement (BPE) on breast MRI. A feasibility study with a semi-automatic and automatic software compared to observer-based scores.
        Br J Radiol. 2015; 88: 20150417
        • Yoon H.J.
        • Kim Y.
        • Lee J.E.
        • et al.
        Background 99mTc-methoxyisobutylisonitrile uptake of breast-specific gamma imaging in relation to background parenchymal enhancement in magnetic resonance imaging.
        Eur Radiol. 2015; 25: 32-40
        • Grimm L.J.
        • Anderson A.L.
        • Baker J.A.
        • et al.
        Interobserver variability between breast imagers using the fifth edition of the BI-RADS MRI Lexicon.
        AJR Am J Roentgenol. 2015; 204: 1120-1124
        • National Cancer Institute
        Breast Cancer Risk Assessment Tool.
        (Available at:)
        Date accessed: March 15, 2017
        • Breast Cancer Surveillance Consortium
        Breast Cancer Surveillance Consortium Risk Calculator.
        (Available at:)
        • International Breast Cancer Intervention Study
        Tyrer-Cuzick Model Breast Cancer Risk Evaluation Tool.
        (Available at:)
        Date accessed: March 15, 2017
        • Vreemann S.
        • Gubern-Merida A.
        • Borelli C.
        • et al.
        The correlation of background parenchymal enhancement in the contralateral breast with patient and tumor characteristics of MRI-screen detected breast cancers.
        PLoS ONE. 2018; 13 (e0191399)